Combining transtracheal catheter oxygenation and needle-based Seldinger cricothyrotomy into a single, sequential procedure
Autor: | Rashmeet Gujral, Teresa Amato, Eric Boccio, Jason D'Amore, Mary Frances Ward, Michael Cassara, Benjamin Wie |
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Rok vydání: | 2015 |
Předmět: |
medicine.medical_specialty
Percutaneous medicine.medical_treatment Punctures Manikins Cricoid Cartilage Cadaver Transtracheal jet ventilation Medicine Humans Cricothyrotomy business.industry General Medicine Oxygenation Emergency department Surgery Oxygen Catheter Needles Anesthesia Emergency Medicine Feasibility Studies Tracheotomy Airway business |
Zdroj: | The American journal of emergency medicine. 33(5) |
ISSN: | 1532-8171 |
Popis: | Background Needle-based cricothyrotomy is a common procedure for emergency department patients requiring an emergent surgical airway. Percutaneous transtracheal jet ventilation is well studied to provide oxygenation. We propose to combine these procedures into a novel, single, and sequential procedure. Methods This study was a prospective manikin/human cadaver procedural feasibility study performed at a medical education center. Forty-eight emergency medicine attending physicians and fellows performed the procedure on a single TraumaMan (Simulab Corporation, Seattle, WA), and 26 were randomly selected to perform the procedure on fresh, unfixed human cadavers. The procedure is as follows: 15 gauge/6F catheter-over-needle punctures cricothyroid membrane, needle is removed, and Enk oxygen flow modulator is attached to the catheter (start to oxygenation). The Enk set is detached, a guide wire introduced, and Seldinger cricothyrotomy is performed (oxygenation to cricothyrotomy). Start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times were recorded. Manikin procedures were verified by direct visualization, and cadaver procedures were verified by video laryngoscopy. Results All attempts were included in data analysis, and there was a 100% first-pass success rate. For the manikin trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 11 (8.5-13), 48 (42-57), and 59 (53-69) seconds, respectively. For the cadaver trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 12 (10-15), 59 (47-76), and 71 (61-94) seconds, respectively. Student t tests showed significant differences in start-to-oxygenation and oxygenation-to-cricothyrotomy times ( P Conclusion Percutaneous transtracheal jet ventilation and needle-based Seldinger cricothyrotomy can be performed by emergency medicine physicians, and a single, sequential procedure may significantly reduce time to oxygenation for patients already undergoing surgical cricothyrotomy. |
Databáze: | OpenAIRE |
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